The dark side of fiscal federalism:evidence from hospital care in Italy

Paolo Berta (), Carla Guerriero () and Rosella Levaggi
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Paolo Berta: Università di Milano Bicocca
Carla Guerriero: Università di Napoli Federico II

Working papers from Società Italiana di Economia Pubblica

Abstract: We use 2009-14 data from patients hospital discharges to assess the effects of fiscal federalism on the quality of care provided to regional and extraregional patients in Lombardy. Empirical results suggest that even after controlling for hospital fixed effects, patients demographic and health characteristics, extraregional patients wait less compared to regional ones, stay longer in hospital and are associated with higher reimbursement costs. However, private and public hospitals with higher proportion of extraregional patients show a lower mortality and lower reimbursement costs. This result suggest that competition works because of the spillovers effects that the market for extraregional patients produces.

Keywords: Hospital competition; patients mobility; mixed market; fiscal federalism (search for similar items in EconPapers)
JEL-codes: C70 D6 H51 H77 (search for similar items in EconPapers)
Date: 2018-09
New Economics Papers: this item is included in nep-eur and nep-hea
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